The dorsalis pedis artery is a continuation of the anterior tibial artery into the foot. It is located lateral to the extensor hallucis longus tendon that functions to extend the big toe. On exam, track the extensor hallucis longus tendon and palpate for the DP pulse lateral to the tendon on the dorsum of the midfoot at the level of the navicular bone.
Posterior Tibal Pulse
The posterior tibial artery is a continuation of the popliteal artery into the foot. It is located between the posterior medial malleolus and the Achilles tendon. On exam, feel for the medial malleolus and slide your hand posteriorly and palpate in the space between the medial malleolus and the Achilles tendon.
Pulsus Parvus Et Tardus – Small amplitude with delayed timing. Often associated with aortic stenosis.
Water-Hammer (“Corrigan’s Pulse”) – Brisk upstroke with large amplitude and rapid collapse. Often indicates the presence of aortic insufficiency but can also be seen in thyrotoxicosis, patent ductus arteriosis, and A-V fistulas.
Pulsus Bisferiens (“Bifid Pulse”) – Two separate peaks during systole. Often seen in patients with aortic insufficiency or combined aortic stenosis and insufficiency.
Pulsus Alternans – Variable expression of the carotid amplitude, often indicating severe left ventricular systolic dysfunction.